Abstract
ObjectivesTo prospectively compare unenhanced quiescent-interval single-shot MR angiography (QISS-MRA) with contrast-enhanced computed tomography angiography (CTA) for contrast-free guidance in transcatheter aortic valve intervention (TAVI).MethodsTwenty-six patients (mean age 83 ± 5 years, 15 female [58%]) referred for TAVI evaluation underwent QISS-MRA for aortoiliofemoral access guidance and non-contrast three-dimensional (3D) “whole heart” MRI for prosthesis sizing on a 1.5-T system. Contrast-enhanced CTA was performed as imaging gold standard for TAVI planning. Image quality was assessed by a 4-point Likert scale; continuous MRA and CTA measurements were compared with regression and Bland-Altman analyses.ResultsQISS-MRA and CTA-based measurements of aortoiliofemoral vessel diameters correlated moderately to very strong (r = 0.572 to 0.851, all p ≤ 0.002) with good to excellent inter-observer reliability (intra-class correlation coefficient (ICC) = 0.862 to 0.999, all p < 0.0001) regarding QISS assessment. Mean diameters of the infrarenal aorta and iliofemoral vessels differed significantly (bias 0.37 to 0.98 mm, p = 0.041 to < 0.0001) between the two modalities. However, inter-method decision for transfemoral access route was comparable (κ = 0.866, p < 0.0001). Aortic root parameters assessed by 3D whole heart MRI strongly correlated (r = 0.679 to 0.887, all p ≤ 0.0001) to CTA measurements.ConclusionQISS-MRA provides contrast-free access route evaluation in TAVI patients with moderate to strong correlations compared with CTA and substantial inter-observer agreement. Despite some significant differences in minimal vessel diameters, inter-method agreement for transfemoral accessibility is strong. Combination with 3D whole heart MRI facilitates unenhanced TAVI guidance.Key Points• QISS-MRA and CTA inter-method agreement for transfemoral approach is strong.• QISS-MRA is a very good alternative to CTA and MRA especially in patients with Kidney Disease Outcomes Quality Initiativestages 4 and 5.• Combination of QISS-MRA and 3D “whole heart” MRI facilitates fully unenhanced TAVI guidance.
Highlights
Material and methodsTwenty-six patients referred for transcatheter aortic valve intervention (TAVI) evaluation underwent non-contrast MRI and additional computed tomography angiography (CTA) within 1 day (interquartile range (IQR) 0–2 days)
QISS-MRA provides contrast-free access route evaluation in TAVI patients with moderate to strong correlations compared with CTA and substantial inter-observer agreement
General inclusion criteria were severe aortic stenosis according to recent guidelines with the decision for TAVI procedure by an interdisciplinary heart team and typical symptoms of severe aortic stenosis like shortness of breath, angina, or syncope [11, 12]
Summary
Twenty-six patients (mean age 83 ± 5 years) referred for TAVI evaluation underwent non-contrast MRI and additional CTA within 1 day (interquartile range (IQR) 0–2 days). In addition to the 26 patients who received both MRI and CTA examinations, nine additional patients underwent a MRI scan exclusively. This results in a MRI cohort of a total of 35 patients for inter-observer comparison and image quality evaluation of QISS-MRA. Local ethics committee approval was provided prior to inclusion of the first patient and written informed consent was obtained from each participant. Exclusion criteria were contraindications to perform MRI or CTA; contraindications for TAVI and Killip class ≥ 3 General inclusion criteria were severe aortic stenosis according to recent guidelines (aortic valve area ≤ 1.0 cm or aortic valve index ≤ 0.6 cm2/m2) with the decision for TAVI procedure by an interdisciplinary heart team and typical symptoms of severe aortic stenosis like shortness of breath, angina, or syncope [11, 12].
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